Provider Demographics
NPI:1811376445
Name:MYC URGENT CARE LLC
Entity Type:Organization
Organization Name:MYC URGENT CARE LLC
Other - Org Name:MYC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-515-8700
Mailing Address - Street 1:106 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3981
Mailing Address - Country:US
Mailing Address - Phone:972-515-8700
Mailing Address - Fax:469-218-0681
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3981
Practice Address - Country:US
Practice Address - Phone:972-515-8700
Practice Address - Fax:469-218-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4319174400000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty